On Health-Care Reform, Obama Looks to the LBJ Model
President Urges Lawmakers to Act

By Ceci Connolly
Washington Post Staff Writer
Tuesday, July 14, 2009

President Obama returned to domestic affairs yesterday after a weeklong overseas tour with a warning for skeptics of his stalled health-care overhaul: "Don't bet against us."

The tough talk in the Rose Garden gave way hours later to behind-the-scenes Lyndon B. Johnson-style lobbying, as Obama pledged in a pair of private meetings with Democratic lawmakers to stake his political capital on this year's top agenda item.

"I just want to put everybody on notice because there was a lot of chatter during the week that I was gone," he said. "Inaction is not an option."

Despite Obama's forceful reengagement, congressional Democrats continued to struggle last night to finalize details of legislation aimed at overhauling the nation's health-care system. House leaders wrangled with rank-and-file members over plans to pay for expanded insurance coverage by increasing taxes on the wealthiest Americans.

At the White House session, Senate leaders came under fire for a slipping timetable that may make it difficult to meet Obama's deadline for floor action by the August recess.

"The urgency barometer is up," Senate Finance Committee Chairman Max Baucus (D-Mont.) said after the meeting.

Obama conveyed to the Senate leaders that he still expects the committee to begin action next week, two Democratic sources said.

The legislative tussles spoke to the daunting challenge of remaking a health system that consumes $1 out of every $6 spent in the country and illustrated why many reform advocates have been clamoring for Obama, who has studied the Johnson model, to dive deeper into the high-stakes battle.

"Members understand this is really the centerpiece to the president's agenda. They understand he values their input and their concerns," said Rep. Diana DeGette (D-Colo.), who spent three days last week listening to House colleagues catalog their questions, fears and gripes about the proposed bill. "Now that health care's front and center in both the House and Senate, he should have even more of an impact."

In sessions with Democrats, Obama and his advisers remind lawmakers that the defeat of President Bill Clinton's health-care overhaul spelled electoral disaster for the party in 1994, costing Democrats control of both the House and Senate.

"Behind closed doors, he essentially says: If this sinks, we will have trouble in 2010," said Jim Kessler, vice president for policy at the moderate Third Way think tank. "If this goes down, they will lose a whole lot of momentum on everything else. Clinton's whole agenda went down" after the reform's defeat.

In mapping its strategy, the Obama team chose to take its cues from another Democratic senator-turned-president: following the legislative model employed by Johnson to enact Medicare in 1965.

"There are two qualities these presidents have in common," said White House senior adviser David Axelrod. Like Obama, Johnson "had a big vision and drove the country toward it, and second, he had a great appreciation for the legislative process."

Early on, Obama and health czar Nancy-Ann DeParle discussed the parallels with Johnson and creation of the health program that serves 45 million seniors and people with disabilities today. Just as Johnson gave legendary lawmaker Wilbur Mills (D-Ark.) latitude to craft the Medicare bill, Obama has asked Congress to write the health-care revamp legislation.

And just as Johnson was known for his powers of personal persuasion, Obama, a former senator himself, has assiduously cultivated and cajoled lawmakers.

"He becomes Lyndon Johnson in a more graceful form but just as steely," said Sen. John D. Rockefeller IV (D-W.Va.). "Obama isn't a toucher" like Johnson, Rockefeller said, "it's just intellect, this sort of streaming knowledge and a deep voice that never seems to get weary. It's clear he has to have this."

Obama devotes at least one hour a day to health care, often studying briefing memos about individual lawmakers and their pet issues, said one White House aide. The topic is woven into most of his public appearances, as he "makes the case that inaction has disastrous implications for the future," Axelrod said.

In private meetings or phone calls with legislators, Obama "has an easy familiarity," said DeParle, who often joins the sessions. "He has a way of getting right to the heart of the matter. He's pushing and prodding and giving no ground."

When the president leans back in his chair, flashing a broad smile, "he is very persuasive," she said. After he listens to lawmakers' concerns, he often replies: "There's no reason to delay."

As a reminder of the blueprint they have settled on, DeParle keeps a Johnson quotation under glass on her desk, just above the keyboard. It reads: "There is but one way for a president to deal with the Congress, and that is continuously, incessantly, and without interruption."

Obama has lavished attention on moderate GOP senators such as Olympia J. Snowe (Maine) and Charles E. Grassley (Iowa), who provide the seal of bipartisanship he covets. His message to Snowe, like many others, is that "this is his highest domestic priority, and he wants to get it accomplished and done this year," she said. "I indicated to him it was important to be flexible on the time frame and on trying to draft the substance of legislative policy."

Snowe and Rockefeller praised Obama for his deference to the legislative branch, but both signaled he may soon have to wade into the messier details of the bill.

"At some point, the president's going to have to play a pivotal role in shaping what happens," Snowe said. "It is crucial."

On Capitol Hill, conservative House Democrats are pushing back against a graduated surtax on incomes exceeding $350,000 a year, saying the plan would unduly increase the highest marginal tax rate. Many senators expressed a distaste for any tax increase for the wealthy.

Obama appeared undeterred.

"I understand people are a little nervous and a little scared about making change," he said. "The muscles in this town to bring about big changes are a little atrophied, but we're whipping folks back into shape."